Abstract Body: Background: Cervical artery dissection (CAD) is a leading cause of stroke in young adults, accounting for up to 25% of strokes in this population. Despite its prevalence, there is considerable variability in the management of CAD due to the lack of large-scale randomized trials and inconsistent findings in existing literature. This study aims to assess global treatment practices for CAD and evaluate the consistency of clinical decision-making among stroke physicians using a structured survey.
Methods: An international survey was distributed to stroke physicians and trainees, including those from the STOP-CAD and TREAT-CAD studies. The survey explored multiple aspects of CAD management, including patient characteristics influencing treatment choices, preferred antithrombotics, treatment duration, and criteria for stopping therapy. Six case-based scenarios were also included to evaluate initial treatment decisions, follow-up imaging practices, and medication duration. Responses were analyzed using Krippendorff’s alpha to quantify inter-rater reliability and assess the degree of consensus among respondents. The data was further analyzed in order to evaluate inter-rater reliability for the case scenarios.
Results: The survey was completed by 102 stroke neurologists, revealing a moderate overall agreement with a Krippendorff’s alpha of 0.481. Detailed analysis indicated significant variability in responses across different aspects of CAD management, particularly regarding the choice of anticoagulants and treatment duration. While some areas showed higher levels of consensus, the overall variability highlights the lack of standardized practices. Table 1 presents Krippendorff’s alpha values for each of the six case scenarios, assessing overall agreement among respondents within each case. Table 2 provides Krippendorff’s alpha values for each of the five questions within each scenario, examining response consistency for each question across all scenarios.
Conclusions: The observed variability in CAD management underscores the critical need for further research to establish optimal treatment strategies. While variability itself is not inherently problematic, it suggests that some clinicians may unknowingly provide suboptimal care due to inconsistent practices. This study highlights the importance of developing evidence-based guidelines to reduce uncertainty, ensure optimal care, and improve patient outcomes in CAD treatment.